The morphology and distribution of breast calcifications can often indicate their etiology. Certain patterns are never associated with malignancy. Common types of typical calcifications are:
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- Vascular Calcifications within arterial walls due to athero- sclerosis produces the characteristic pattern of two parallel calcific lines: 'Train Track' appearance [Figure - 1]. As with most arterial deposits, these are calcifications in the intima of the arterial wall.
- Large, linear, solid, rod shaped calcifications conforming to the lumen of the duct are benign if they are solid and continuous without branching. These thick (greater than 0.5 mm in diameter) rods are the result of calcification of the debris that has collected in the duct. The process has been named 'Secretory disease' [Figure - 2],[Figure - 3]. However if the linear calcifications are very small and linear distribution is with branching, the possibility of ductal carcinoma-in-situ should be considered.
- Lucent centered calcifications are always due to a benign process and may represent secretory deposits, areas of fat necrosis, or may be in the skin and not in the breast itself[Figure - 4],[Figure5].
- Fibroadenomas calcify as they undergo myxoid degeneration. Early calcification in a fibroadenoma frequently occurs at the periphery of the mass. Popcorn calcifications are typical of an involuting fibroadenoma [Figure - 6]. Large, irregularly shaped calcifications always indicate an involuting fibroadenoma [Figure7].
- Thin rim calcifications usually delineate the wall of a cyst. Calcifications confirming to the wall of the sphere are due to a benign process. Sometimes the whole cyst may get calcified [Figure - 8],[Figure9]. Atypical irregular rim calcifications are probably associated with intraductal papilloma [Figure - 10]
- Small pin point deposits, Punctate calcifications, are seen in fibrous stroma with no apparent etiology [Figure - 11],[Figure - 12].
- Five or more calcifications, measuring less than one millimeter, in a volume of one cubic centimeter, define a 'cluster'. The possibility of malignancy increases as the size of the individual calcification decreases, the total number of calcifications per limit area increases and the risk increases when they are heterogeneous in size and shape [Figure - 13].
- Calcifications that occupy a large volume of tissue, but not the entire breast are termed 'regionally distributed'. Benign forms of calcification tend to have similar shapes. But if the particles are pleomorphic and dense for their small size, cancer is likely [Figure - 14].
- Palpable lump in the region of the axillary tail may turn out to be enlarged calcified nodes on mammography [Figure - 15][7].
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